Rheumatic heart disease in rural south India: A clinico-observational study

Abstract

a b s t r a c tBackground: Rheumatic heart disease (RHD) is still a public health issue in many countries in the world, and particularly in Southeast Asia. India, for example, contributes 25%e50% of the global burden of RHD. Clinic-based and epidemiological studies on RHD in India have used different methodologies and clinical criteria to estimate RHD burden in India. The present study employs strict clinical criteria, including echocardiography, to estimate RHD prevalence and associated clinical complications in a large unique rural population in southern India covered through a governmental health insurance scheme. Materials and methods: Total 44,164 eligible patients were screened from 238 primary care health centers in rural southern India between October 2007 and March 2012 using strict clinical criteria and objective ascertainment. A total of 403 patients aged 15 years or above were finally analyzed based on both the inclusion and exclusion criteria. Detailed information on both demographic and clinical characteristics was obtained through personal interviews and clinical examinations. Descriptive analyses were performed, including age standardization. Results: The age-standardized RHD prevalence rate was 9.7/1000 populationsdmore common in younger age groups (<44 years) and relatively high among females. Pulmonary hypertension was the most common clinical complication followed by CHF, tricuspid regurgitation, as well as infective endocarditis. More than two-thirds had no past history of RHD or penicillin prophylaxis. Conclusions: RHD rates are still high in rural India among populations covered through governmental health insurance scheme. Both primary and secondary preventive measures, including widespread coverage of penicillin prophylaxis, must be considered mainstay tools to both prevent and reduce RHD burden in endemic populations, including rural India.

Prevalence and progression of rheumatic heart disease: a global systematic review and meta-analysis of population-based echocardiographic studies

“…Indeed, studies have shown significant differences in the prevalence of RHD, when the WHO diagnostic criteria of 2006 is compared with the WHF criteria of 2012 76 . Also, the WHF diagnostic criteria of 2012 have not been universally accepted 52,53,59 . Consequently, alternative guidelines have been adopted in many countries 115 .…”

A Study of Clinical, Microbiological, and Echocardiographic Profile of Patients of Infective Endocarditis

“…This nonuniformity most probably depicts the heterogeneity of the risk factors and presenting population of IE pertaining to their region of study. Incidentally, the prevalence of RHD in India, as documented by various population-based studies in the recent decade, is 5.8–9.7/1000 population [ 28 , 29 ], which arguably is one of the highest in the world. Concurrently, the presence of uncorrected CHD in children less than 15 years in India has been speculated in few studies as 4.2/1000 population [ 30 ], but no systematic data on prevalence among adults was available.…”

Epidemiology of atrial fibrillation

“…Another prospective study in Germany reported an overall prevalence of AF slightly higher than the Italian study, ie, 28.6% in 692 patients with ischaemic stroke or transient ischaemic attack, with prevalence increasing with age . Hanchate et al reported a similar prevalence of AF in the USA in 2013 (ie, 23% in acute ischaemic stroke patients from 8 states), in 2 European studies (24.6% and 28.6%, respectively) and an Australian study (25%; study population 26 960) . However, the prevalence of AF was reportedly lower in some Asian countries, approximately 10% in China, 5.8%‐6% in India, but higher in Japan (32%) …”

“…Differences in the incidence and prevalence rates between studies is likely dependent on the time the study was conducted, the design (nationwide studies, medical insurance databases etc., retrospective, prospective, cross‐sectional) and the study population (age of patients, urban compared with remote areas as their risk factors may vary, for example the prevalence of rheumatic heart disease is higher in rural populations in India) which in turn effects the quality of data obtained …”